EVIDENCE BASED PADA

PENDIDIKAN VOKASI

By: Nursalam

CURRICULUM VITAE

Name : Prof. Dr. Nursalam, M.Nurs (Hons) 081339650000

Address : Jl. Keputih Tegal Timur 62 Surabaya 60111

E-mail : nursalam@fkp.unair.ac.id

HIGHER, EDUCATION: 1. Doctor, Model of Nursing Care for HIV-AIDS, Postgraduate Programme,

Airlangga University, 2005

2. Honours Master of Nursing,, University of Wollongong, New South

Wales, Australia, 1997

3. Master of Nursing (Coursework), Univ. Wollongong, NSW, Australia,1996

4. Med. Surgical Nursing, Lambton College, Sarnia Ontario Canada, 1991

5. Diploma III in Nursing, Sutoma Surabaya 1988

ORGANISATION AND WORKING EXPERIENCES : 1. Lecturer and nurse in Diploma III in Nursing, Anesthesia, Ministry of Health, RI Surabaya (1988 – 1997)

2. Lecturer in School of Nursing, Faculty of Medicine / Faculty of Nursing, Airlangga University (since 1998)

3. Vice, Head, School of Nursing, Faculty of Medicine, UA (1999– 2008)

4. Vice Head, PPNI Educatin & Training, East Java Nursing Association (2000 – 2010)

5. Dean, Faculty of Nursing Airlangga University (2008 – 2010)

6. Nursing Manager, Airlangga University Hospital (2011-now)

PUBLICATION : 1. Books = 15

2. Acredited journal & (national & international)= 75

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OUTLINE

1. INTRODUCTION

2. WHY?

3. WHAT?

4. HOW TO?

5. CONCLUSION

PILIHAN DI SIMPANG JALAN

nursalam-2014

“Two roads diverged in wood and I took the

one less travelled by and that has made all

the difference”(Roberst Frost)

“The more superior brain you have, the more you love

God”. APA YG DISYUKURI Syukur -.... Syukur - jadi orang beriman

- jadi orang Indonesia

- punya pekerjaan baik sbg perawat / nakes PNS -Keluarga & teman baik

-Sedih kalau berbuat jelek

(A. Sahab, 2015)

1

INTRODUCTION – TUJUAN MEA

Memfasilitasi mobilitas para profesional dalam lingkup ASEAN

Pertukaran informasi, meningkatkan kerjasama dan penghargaan pengakuan praktisi kesehatan

Meningkatkan adopsi best practice dalam standar dan kualifikasi

Memberi kesempatan peningkatan kapasitas dan pelatihan praktisi kesehatan

Tenaga di Bidang Kesehatan

UU Nakes 36/2014

Tenaga Kesehatan

1

Asisten Tenaga

Kesehatan 2

Kementerian Kesehatan RI 6

Tenaga Kesehatan (Nakes)

1. Tenaga Medis

2. Tenaga Psikologi Klinis

3. Tenaga Keperawatan

4. Tenaga Kebidanan

5. Tenaga Kefarmasian

6. Tenaga Kesehatan Masyarakat

7. Tenaga Kesehatan Lingkungan

8. Tenaga Gizi

9. Tenaga Keterapian Fisik

10. Tenaga Keteknisian Medis

11. Teknik Biomedika

12. Tenaga Kesehatan Tradisional

13. Tenaga Kesehatan Lain (kesgi,

analis .....)

Kualifikasi

minimum

Diploma Tiga,

kecuali tenaga

medis.

Kementerian Kesehatan RI 7

Kualifikasi minimum

pendidikan menengah di

bidang kesehatan

Bekerja di bawah

supervisi tenaga

kesehatan

Asisten Tenaga Kesehatan

Asisten Tenaga

Kesehatan

Kementerian Kesehatan RI 8

UU KEP. 38/2014

JENIS PERAWAT

PERAWAT PROFESI

• Ners; dan

• Ners spesialis.

PERAWAT VOKASI

• AMd. - D3 (MINIMUM D3 KEPERAWATAN)

PENDIDIKAN TINGGI

KEPERAWATAN (Ps 5, 6, 7, 8)

• Program diploma keperawatan (min D3)

Pendidikan vokasi

• Program sarjana keperawatan (S.Kep)

• Program magister keperawatan (M.Kep)

• Program doktor keperawatan (Dr.)

Pendidikan akademik

• Program profesi keperawatan (ns)

• Program spesialis keperawatan (Sp.)

Pendidikan profesi

1

2

3

4

5

7

8

9

6

TERCANTUM

DALAM DESKRIPSI

UMUM KKNI

SEBAGIAN

DITETAPKAN DLM

SNPT SEBAGIAN

DIUSULKAN FORUM

PRODI

DITETAPKAN

MENTERI ATAS

USUL FORUM PRODI

SESUAI RUMPUN

ILMU

KEMAMPUAN

KERJA UMUM

DITETAPKAN

DALAM SNPT

KEMAMPUAN

KERJA KHUSUS

DITETAPKAN

MENTERI ATAS

USUL FORUM

PRODI

endrotomoits@yahoo.com

Pelatihan Preceptorship_2014 11

Konsep rumusan capaian

pembelajaran minimal lulusan

program studi

1. Sikap dan Tata nilai

2. Kemampuan kerja umum

3. Kemampuan kerja khusus

4. Penguasaan pengetahuan

5. Hak, kewenangan dan tanggung

jawab

Pelatihan Preceptorship_2014 12

LEVEL 5 KKNI

(lulusan D3)

• Mampu menyelesaikan pekerjaan berlingkup luas, memilih metode yang

sesuai dari beragam pilihan yang sudah maupun belum baku dengan

menganalisis data, serta mampu menunjukkan kinerja dengan mutu dan

kuantitas yang terukur.

• Menguasai konsep teoritis bidang pengetahuan tertentu secara umum, serta

mampu memformulasikan penyelesaian masalah prosedural.

• Mampu mengelola kelompok kerja dan menyusun laporan tertulis secara

komprehensif.

• Bertanggung jawab pada pekerjaan sendiri dan dapat diberi tanggung jawab

atas pencapaian hasil kerja kelompok.

LEVEL 6 KKNI (Sarjana S1 dan D4)

• Mampu memanfaatkan IPTEKS dalam bidang keahliannya, dan

mampu beradaptasi terhadap situasi yang dihadapi dalam

penyelesaian masalah.

• Menguasai konsep teoritis bidang pengetahuan tertentu secara umum

dan konsep teoritis bagian khusus dalam bidang pengetahuan tersebut

secara mendalam, serta mampu memformulasikan penyelesaian

masalah prosedural.

• Mampu mengambil keputusan strategis berdasarkan analisis

informasi dan data, dan memberikan petunjuk dalam memilih

berbagai alternatif solusi.

• Bertanggung jawab pada pekerjaan sendiri dan dapat diberi tanggung

jawab atas pencapaian hasil kerja organisasi.

LEVEL 7 (PENDIDIKAN PROFESI )

• Mampu merencanakan dan mengelola sumberdaya di bawah

tanggung jawabnya, dan mengevaluasi secara komprehensif

kerjanya dengan memanfaatkan IPTEKS untuk menghasilkan

langkah-langkah pengembangan strategis organisasi.

• Mampu memecahkan permasalahan sains, teknologi, dan atau

seni di dalam bidang keilmuannya melalui pendekatan

monodisipliner.

• Mampu melakukan riset dan mengambil keputusan strategis

dengan akuntabilitas dan tanggung jawab penuh atas semua

aspek yang berada di bawah tanggung jawab bidang

keahliannya.

nursalam-2014

VOCATIONAL 1. Vocational is whatever helps someone with a health problem to stay at,

return to and remain in work.

2. There is a good business case for vocational , and more evidence on cost-

benefits than for many health and social policy areas.

3. Common health problems should get high priority, because they account for

about two-thirds of long-term sickness absence and incapacity benefits and

much of this should be preventable.

4. Vocational depends on work-focused healthcare and accommodating

workplaces.

5. Most people with common health problems can be helped to return to work

by following a few basic principles of healthcare and workplace

management.

6. Pathways to work increases for vocational underpinned by education to

inform the public, health professionals, and employers about the value of

work for health and recovery.

CHARACTERISTICS –

VOCATIONAL “NAKES”

-A: Attitude

-K: knowledge

-S: skill

-I: insight

Aims of vocational Health

worker To promote health

To prevent illness

To restore health

To facilitate coping with disability or

death

10 Cs CARING

COMMUNICATION

COLLABORATION

CONSITENCE

CAREFULNESS

COMPASSION

COURTESY

COMPETENT

CONFIDENCE

COMMITMENT

(BILA PASIEN ITU SAYA / SAUDARA....)

PRINCIPLE OF CARING

PATIENT-CENTRED

CARE & PATIENT SAFETY

“BPIS”

KARS, 2014

How to achieve?

Nursing Responsibilities in Patient-

Centered Approaches (Faye Abdellah) Effective communication between patient and

caregiver. Information is accurate, timely and

appropriate.

Do everything possible to alleviate patients‟ pain

and make them feel comfortable.

We provide emotional support and alleviate fears

and anxiety.

We involve family and friends in every phase of

our patients‟ care.

We ensure a smooth transition and continuity

from one focus of care to another.

We guarantee every member of our community has

access to our care (BPJS / poor / general)

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PRINCIPLES ..... SHIFTING THE

CULTURE OF CARING

Everyone‟s

Responsibility

For Every

Patient Everyday

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2. WHY?

“It is not enough for

students to be smart; we

must teach them to be

good’ (Aristotle)

ISSUES …..PATIENT

SAFETY

The greatest difficulty in the world is

not for people to accept new ideas,

but to make them forget about old

ideas”

KURIKULUM-NERS-NURSALAM

JOB

OPPORTUNITY EDUCATION

PROGRAM

EDUCATION

OUTCOME ?

(FACULTY) (FACTORY)

1. PROSPEK PEKERJAAN LULUSAN 2. BEBAN TAMBAHAN PEMERINTAH 3. KELEBIHAN PASOK LULUSAN 4. PERSAINGAN PT 5. PEMANNFAATAN SDM 6. PERGESERAN INTERNAL

KEBUTUHAN PASAR

19/6/2013

Why should we worry

about using Evidence

Supported Treatments?

Why Evidence-Based Practice Now?

•A growing body of scientific knowledge

•Increased interest in consistent application of quality services

•Increased interest in outcomes and accountability by funders

•Because they work !!

Charles Wilson, MSSW, Executive Director of Chadwick Center

The Sam and Rose Stein Chair on Child Protection

Rady Children’s Hospital-San Diego

28

QUALITY PRINCIPLES-

“S-T-E-E-E-P” SAFE: avoiding injuries to patients from the care that is intended to help them

TIMELY: reducing waits and sometimes harmful delays for both those who receive and those who give care

EFFECTIVE: providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse)

EFFICIENT: avoiding waste, in particular waste of equipment, supplies, ideas, and energy

EQUITABLE: FAIR, providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status

PATIENT-CENTERED: providing care that is respectful of and responsive to

individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions

“STEEEP” Framework outlined by the Institute of Medicine (“IOM”)

Why Evidence-Based Practice

Fueled by accrediting bodies, professional

organizations, third party payers

Potential to improve quality, reduce variations in

care

Focus on practices that result in best possible

outcomes at possibly lower cost

Provides a way to keep pace with advances

CONT’.. Why Evidence-Based

Practice Potential to narrow the „research-practice gap‟:

adoption of research findings into practice can

take as long as 17 years (Balas & Boren)

Impacted by perception that published research is not relevant to practice

Provides a means to answer problematic clinical

practice issues

Potential to improve individual bedside practice; supports/improves clinical decision-making skills

Bedside nurse as conduit!!

nursalam-2014

3. WHAT?

Definition

“Process by which nurse, midwife,

others health worker make clinical

decisions using best available evidence,

clinical expertise, & patient

preferences in the context of available

resources” (DiCenso, 1998)

What is

Evidence-Based Practice

Builds on process of research use, but more encompassing

More specific than term „best practices‟

Does not foster rigid adherence to standardized guidelines

Recognizes the role of clinical expertise

EB practice is a state of mind!

Evidence-Based Practice

Evidence-based practice (EBP) is like a

toolbox of methods available to the vocational

/ practitioner to aid clinical reasoning. The

toolbox consists primarily of methods

designed to integrate current and best

evidence from research studies into the

clinical reasoning process.

Tickle-Degnen, 2000

Steps in Evidence Based

Practice Process

Identify a practice issue

Formulate an answerable question

Search for best evidence

Critically evaluate the evidence and clinical relevance

Make recommendations

Apply to clinical practice

Evaluate impact/effectiveness/ outcomes

Levels of Evidence Hierarchy

(Stetler et al.)*

Level I: Meta-analysis of multiple RCTs

(„gold standard‟)

Level II: Individual RCTs

Level III: Quasi-experimental

Level IV: Non-experimental; qualitative

Level V: Program evaluation; QI; RU; case reports

Level VI: Opinion of respected authorities

*modified slightly by Padula

What to look for in Practice? Treatment or intervention protocol that has at least some

scientific, empirical research evidence for its efficacy with its intended target problems and populations.

Evidence may be based on a variety of research designs.

– Randomized Clinical Trial (RCT)

– Controlled studies without randomization

– Open trials, pre- post-, or uncontrolled studies

– Multiple baseline, single case designs

The degree to which we are persuaded that the treatment is effective will vary by the quality of empirical support.

– Number of RCT‟s

– Replication by researchers other than the treatment developers

– Sampling, sample size used, comparison treatment, effect size

Various methods have been developed for classifying the level of empirical support enjoyed by treatment approaches.

– Should be useful for front-line practitioners

What are Core Competencies?

Ask: why are we doing this.. what is the evidence?

Think critically!

Think out of the box!

Prioritize and clearly articulate answerable

clinical questions with a focus on outcomes

Appreciate role of quality improvement activities

Evaluate practice outcomes

*Work effectively with others

Search for evidence

• Evaluate the evidence

Core Competencies (cont.)

Read and understand

research

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4. HOW TO?

How do you expect to get from

CURRENT EBP

PRACTICE

• Where are you now?

• Where do you want to be?

• Potential Barriers to change?

• Possible facilitators to Change?

=HOW to get to desired outcomes, EBP

nursalam-MASALAH

nursalam-MASALAH

Forming A Good Questions:

EVIDENCE BASED - PICO P = Patient population or disease of interest (age, gender,

ethnicity, with a certain disorder hepatitis)

I = Intervention or range of interventions of interest (exposure to disease, prognostic factor A, risk behavior)

C = Comparison, you want to compare the intervention against (no disease, placebo or no intervention, prognostic factor B, absence of risk factor)

O = Outcome of interest (accuracy of diagnosis, rate of occurrence of adverse outcome)

In (P) immobile acute care patients, what is the effect

of (I) turning every 2 hours on (O) prevention of

pressure ulcers compared with (C) not turning

patients every 2 hours?

P-I-C-O-T (Nancy M. Heddle, 2006)

P I C O T

Consider:

• Gender

• Age

• Diagnostic

category

• In

patient/outpa

tient

Consider:

• Dose (low or

high)

• How to define

dose

• Platelet type

(apheresis,

whole blood

derived)

• Prophylactic

and/or

therapeutic

Consider:

• Standard

dose or no

platelets

• Platelet type

(apheresis or

therapeutic)

• Prophylactic

and/or

therapeutic

Consider:

• Morbidity or

mortality

• Bleeding (what

severity)

• Post transfusion

platelet count

• Corrected count

increment

• Blood product

use

Consider:

• How frequently to

assess and

document bleeding

• Platelet count

increment at 1 hour

versus 24 hours

• Duration of followup

(i.e., for a

specified period

after each

transfusion or for

total duration of

platelet

dependency

Example Question

Question: In adults with a diagnosis of acute myeloblastic leukemia who are receiving

prophylactic platelet transfusions, does the transfusion of a high platelet dose (equivalent to 12

whole blood derived platelet products), result in fewer days with bleeding during the period of

thrombocytopenia (WHO Grade = 2), compared to a standard dose platelet transfusion(equivalent to 6

whole blood derived platelets) ?

Question: In adults with a diagnosis of acute myeloblastic leukemia who are receiving

prophylactic platelet transfusions, does the transfusion of a high platelet dose (equivalent to 12 whole

blood derived platelet products), result in fewer days with bleeding during the period of

thrombocytopenia (WHO Grade = 2), compared to a standard dose platelet transfusion (equivalent to 6

whole blood derived platelets) ?

P - adults with a diagnosis

of acute myeloblastic

leukemia who are

receiving prophylactic

platelet transfusions

O – days with bleeding

(WHO Grade = 2)

C – standard dose platelet

transfusion (equivalent

to 6 whole blood

derived platelets)

I - transfusion of a high

platelet dose (equivalent to

12 whole blood derived

platelet products)

T – daily bleeding

assessment during the

period of

thrombocytopenia

CLINICAL PATHWAY : - contoh (word)

Sama dengan care pathway, care map, critical pathway,

integrated care pathways, multi disciplinary pathways of care,

pathways of care, collaborative care pathways.

Merupakan langkah secara details apa yg harus dilakukan dlm

kondisi klinis yang terjadi pada pasien, merupakan rencana

kegiatan day to day dari manajemen pasien

Menggunakan pendekatan multidisiplin karena itu dapat

digunakan format yang sama untuk setiap pemberi asuhan/

pelayanan.

LUWI 21 April 2014

dr Luwi - PMKP 4 maret 13 46

Panduan Praktik Klinis

SMF : Penyakit Dalam

RS Universitas Airlangga Surabaya

DIABETES MELITUS

1. Pengertian

(Definisi)

Penyakit metabolik yang ditandai oleh hiperglikemia akibat defek pada :

1. Kerja insulin (resistensi insulin) di hati (peningkatan produksi gula

hepatic) dan di jaringan perifer (otot dan lemak).

2. Sekresi insulin oleh sel beta pancreas

3. Atau keduanya.

Klasifikasi Diabetes Melitus (DM) :

1. DM tipe 1 (destruksi sel beta, umumnya diikuti defisiensi insulin

absolut)

2. DM tipe 2 (umumnya mulai dari resistensi insulin)

3. DM tipe lain (defek genetic pada fungsi sel beta, defek genetic pada

kerja insulin, penyakit eksokrin pancreas, endokrinopati, diindusi obat,

infeksi, bentuk lain immune mediated DM, sindrom genetic lain)

4. DM gestasional

2. Anamnesis Keluhan klasik : poliuria, polidipsia, polifagia, dan penurunan berat badan yang

tidak dapat dijelaskan sebabnya.

Keluhan lain berupa : lemah badan, kesemutan, gatal, mata kabur, dan

disfungsi ereksi pada pria, serta pruritus vulvae pada wanita.

3. Pemeriksa

an Fisik

Tinggi badan, berat badan, tekanan darah, lingkar pinggang

Tanda neuropati.

Mata (visus, lensa mata dan retina).

Gigi mulut.

Keadaan kaki (termasuk rabaan nadi kaki), kulit dan kuku.

4. Kriteria

Diagnosis

1. Keluhan klasik ditemukan dengan gula darah sewaktu > 200 mg/dl.

2. Pemeriksaan glukosa plasma puasa ≥126 mg/dl dengan keluhan klasik.

3. Kadar gula plasma 2 jam pada tes toleransi glukosa oral (TTGO) ≥ 200

mg/dl (TTGO dilakukan dengan standar WHO, menggunakan beban

glukosa yang setara dengan 75 gram glukosa anhidrus yang dilarutkan

dalam air).

4. Pemeriksaan HBA1c ≥ 6,5%, jika dilakukan pada sarana laboratorium

yang terstandarisasi dengan baik.

5. …………………………………………………………………………….........................

5. Diagnosis ……………………………………………………………………………………………….

6. Diagnosis

Banding

1. Hiperglikemia reaktif

2. Toleransi glukosa terganggu

3. Toleransi glukosa puasa terganggu

7. Pemeriksa

an

Penunjang

1. Gula darah puasa dan 2 jam post prandial

2. HbA1C

3. Profile lipid pada keadaan puasa (kolesterol total, HDL, LDL, dan

trigliserida)

4. Kreatinin serum

5. Urinalisa : proteinuria, keton, sedimen

6. Elektrokardiogram

7. Foto sinar –X dada

1. Terapi 1. Terapi nutrisi medis (diet DM sesuai anjuran ahli gizi)

2. Latihan jasmani aerobic (jalan kaki, bersepeda, jogging, dan renang)

secara teratur (3-4 kali seminggu selama kurang lebih 30 menit)

3. Obat hipoglikemik oral

Pemicu sekresi insulin : sulfonylurea dan glinid

Peningkatan sensitivitas terhadap insulin : metformin dan

tiazolidindion.

Penghambat gluconeogenesis (metformin)

Penghambat absorpsi glukosa : penghambat glukosidase alfa.

DPP-IV (enzim dipeptidyl peptidase-IV) inhibitor

4. Insulin

Insulin kerja cepat (rapid acting insulin)

Insulin kerja pendek (short acting insulin)

Insulin kerja menengah (intermediate acting insulin)

Insulin kerja panjang (long acting insulin)

Insulin campuran (premixed insulin)

5. Kombinasi obat antidiabetik oral dan insulin

2. Edukasi 1. Promosi perilaku sehat

2. Edukasi pola diet DM sesuai anjuran ahli gizi

3. Edukasi kontrol rutin dan penggunaan obat diabetic secara teratur

4. Edukasi penyulit akut dan kronik DM

5. Edukasi deteksi dini kelainan kaki risiko tinggi

6. Edukasi penyakit penyerta DM

3. Prognosis Ad vitam : dubia ad bonam/malam Ad sanationam : dubia ad bonam/malam Ad fumgsionam : dubia ad bonam/malam

4. Tingkat

Evidens

IV

5. Tingkat

Rekomend

asi

C

6. Penelaah

Kritis

1.

2.

7. Indikator

Medis

Evaluasi gula darah plasma dan komplikasi

8. Kepustaka

an

1. Konsensus Pengelolaan dan pencegahan diabetes mellitus di Indonesia,

PERKENI, 2011

2. Panduan pelayanan medik, Perhimpunan Dokter Spesialis Penyakit

Dalam Indonesia, 2006

Surabaya ………………………………….2015

Ketua Komite Medik Ketua SMF...............................................

.................................... ......................................

Direktur RS Universitas Airlangga Surabaya,

.......................................................

Contoh: CLINICAL PATHWAYS

DIABETES MELITUS

Nama Pasien: ……………………………………………………

Umur: ………………

Berat Badan: ……………..kg

Tinggi Badan: …………..cm

Nomor Rekam Medis: …………………………….

Diagnosis Awal: ………………………………. Kode ICD 10 : …………………… Rencana rawat : …… hari

Aktivitas Pelayanan R. Rawat

……………. Tgl/Jam masuk: ……………….

Tgl/Jam keluar: ……………….

Lama Rwt ……... hari

Kelas: ……..

Tarif/hr (Rp): ………….

Biaya (Rp) ……………

Hari Rawat 1 Hari Rawat 2 Hari Rawat 3 Hari Rawat 4 Hari Rawat 5 Hari Rawat 6 Hari Sakit: … Hari Sakit: … Hari Sakit: … Hari Sakit: … Hari Sakit: … Hari Sakit: …

Diagnosis:

Penyakit Utama Diabetes Melitus

Penyakit Penyerta Hipertensi Dislipidemia Congective heart failure

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Komplikasi Ketoasidosis metabolik

Status hipergliemia hyperosmolar

Hipoglikemia

Makroangiopati pembuluh darah koroner

Makroangiopati pembuluh darah tepi

Makroangiopati pembuluh darah otak

Retinopati diabetik

Nefropati diabetik

Neuropati

Kaki diabetik

Disfungsi ereksi

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Asessmen Klinis: Pemeriksaan dokter (+)/(-)

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Konsultasi Interna

Cardio

Bedah

Syaraf

Anestesi

Gizi

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…………..

Pemeriksaan Penunjang: Darah rutin

GDS GDP/GD2JPP HbA1C

Profile lipid,

Ureum/Creatinin

SGOT/SGPT

Serum ekeltrolit

Blood gas analysis

EKG

Ro Thorax

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…………..

Tindakan: Oksigenasi

Pasang IV line

Hidrasi cairan

Pasang kateter

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Aff iv line

Aff kateter

…………..

Obat obatan: Drip insulin sesuai algoritme ……. Unit/jam Drip bicnat …..meq dalam NaCl 0,9%500 cc Drip kalium …..meq dalam NaCl 0,9% 500 cc Insulin short acting 3 x … unit sub cutan Insulin long acting 0 – 0 – 0 - … unit subcutan Antihipertensi Statin 1 x …. mg Obat antidiabetik oral D40% bolus …………………………..

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Rencana pulang : Obat oral

………………. ……………… ……………….

Nutrisi: Diet DM 25-30 kcal/kgBB/hari + factor penyesuaian (usia > 40 tahun, status gizi, stress metabolic, hamil)

Diet sesuai anjuran gizi …………..

Mobilisasi: Semi fowler Duduk Aktif

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…………..

Hasil (Outcome): Klinis : Penurunan kesadaran Hipertensi Sesak Nyeri dada Hipoglikemia Kaki diabetic

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Pendidikan/Rencana Pemulangan: Perjalanan penyakit dan rencana terapi Penjelasan diet makanan Penjelasan untuk kontrol rutin

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Varians:

Jumlah Biaya ………….. Perawat (PPJP)

………………

Diagnosis Akhir: Kode ICD 10 Jenis Tindakan: Kode ICD 9 – CM

PPDU: ……………

Utama Diabetes Melitus ……….. Pasang infus ……………….

PPDS:

…………… Penyerta Hipertensi ……….. Oksigenasi ……………….

Dokter

Penanggung

Jawab Pasien

(DPJP):

.............................

Dislipidemia ……….. Pemasangan kateter ………………. CHF ……….. ……………………………………… ……………….

Komplikasi Ketoasidosis

metabolik ……….. ……………………………………… ……………….

Status hiperglikemia

hyperosmolar ……………………………………… ……………….

Hipoglikemia ……….. ……………………………………… ………………. Makroangiopati

pembuluh darah

koroner

……….. ……………………………………… ……………….

Verifikator: ……………………

Makroangiopati

pembuluh darah otak ……….. ……………………………………… ……………….

Makroangiopati

pembuluh darah tepi ……….. ……………………………………… ……………….

Nefropati Diabetik ……….. ……………………………………… ………………. Retinopati diabetik ……….. ……………………………………… ………………. Neuropati ……….. ……………………………………… ………………. Kaki diabetik ……….. ……………………………………… ……………….

IMPLEMENTASI

“PENCEGAHAN INFEKSI”

Pasien DX MEDIS DX KEPERAWATAN

TN. X, 65 THN Tumor Paru dekstra 1. Intergritas kulit

2. Nyeri akut

3. Resiko ketidakefektifan pola nafas NY. Y, 58 THN DM tipe 2 1. Ketidakseimbangan nutrisi: kurang dari

kebutuhan tubuh

2. Kerusakan integritas kulit TN. A, 50 THN Selulitis + Ulkus cruris +

Abses brachialis dextra + DM

1. PK: Hiperglikemia

2. Kerusakan integritas kulit

TN B, 68 THN OMI anteroseptal + DMND III +

DCFC IV + ISK

1. Penurunan curah jantung

2. Kelebihan volume cairan & integritas

kulit

3. PK: Hiperglikemia

4. PK: Hiponatremia TNY C, 38 THN TB Paru + DILI + Dermatitis

Atopik

1. Nyeri akut

2. Mual

3. Kerusakan integritas kulit

EXAMPLE – DATA

Pasien Intervensi Compara

sion Outcome Teori

317 pasien yang terpasang

infus dan dirawat di

bangsal rumah sakit pusat

di Portugal

Menggunakan 139

instrumen VIP

35 orang dari

317 pasien

mengalami

plebitis

Data dikumpulkan

selama 6 minggu (30

Januari – 12 Maret

2010)

427 pasien yang terpasang

infus dan dirawat di

rumah sakit Italia

Menggunakan

instrumen VIP

276 dari 317

pasien

mengalami

plebitis

Data dikumpulkan tahun

2007. Masing-masing

diteliti selama 12-96 jam

12 pasien dengan aritmia di

ICU yang menerima

aminoderon melalui IV

Infusion nursing standards

of practise / INS

0 : tanpa sign and syptomp

4 : ada sign and symptomp

12 x kejadian

plebitis dari

24x

pemasangan

infus

Penelitian

dilakukan selama 6

bulan (2009)

Incidence and severity of

phlebitis in patients

receiving peripherally

infused amiodaron

EXAMPLE – 1) RESEARH EVIDENCE & BASED THEORY

Pasien Intervensi Comparasion Outcome Teori

Ny. K (P/ 57

tahun)

DMND + DCFC

IV

Penggantian balutan insersi

intravena dengan transparan

dressing

Mobilisasi: bebas

Nutrisi: cukup

Personal Hygiene: baik

IV cath taka no 22

NaCl 0,9 % 500 cc/24 jam

Dopamin 3 mikro/24 jam

stand by

Furosemid 3 x 40 mg

Pemasangan tanggal

01/01/2015 jam

19.30 WIB

penggantian pada

hari ke 4, dan

kemudian tiap 3

hari

Tidak ada tanda

plebitis

The Centers for Disease

Control and Prevention

menganjurkan

penggantian katheter stiap

72-96 jam untuk

membatasi potensi infeksi

(Darmawan, 2008)

Ny. F (P/ 40 tahun)

Gastritis akut DM

(40thn)

Mobilisasi:

bebas

Penggantian balutan insersi

intravena dengan transparan

dressing

1. Nutrisi: cukup

2. Personal Hygiene: baik

3. IV taki no 22

4. Antrain 2x 1000 mg

Asering 500 cc /24 jam

Primperan 3 x 10 mg

Pemasangan tanggal

01/01/2015 jam

12.15 WIB

penggantian pada

hari ke 3

Tidak ada tanda

plebitis

The Centers for Disease

Control and Prevention

menganjurkan

penggantian katheter stiap

72-96 jam untuk

membatasi potensi infeksi

(Darmawan, 2008)

EXAMPLE – 2) EVIDENCED FROM ASSESSMENT

PATIENT & PATIENT VALUES

INTEGRATED NOTES

SOR-Source Oriented Record

SOURCES /

PROFESSI

ON

TIME INTEGRATED NOTES

dr. A

Ns. X

Ns. X

Pharmacy

07.00

08.00

09.00

:

:

14.00

SOAP

-Chek DL

-IV RL

-…

-Blood sampling

-IV Line on the left hend

- VS= TD: 110/70mmHg, N: 80x/mnt, S: 38,2oC, RR:20x/mnt

-Administering antibiotic IM

S=

B=

A=

R=

Ns. Y 14.30 -… nursalam-2014

INTEGRATED NOTES

Professional Expertise

Clinical Decision Making

Client Evidence

Research Evidence

3) PROFESSIONAL EXPERTISE

in Client-Centred Evidence-Based Practice

Clinical Practice Guidelines

The Role of Professional Expertise in CCEP

C

L

I

E

N

T

Stage 1

Client

Evidence

1. Gather and

appraise client

evidence

2. Identify

occupational

performance

issues

Collaborative

Role

Professional

& Client

Re-thinking Professional Expertise

in Client-Centred Evidence-Based Practice

O

U

T

C

O

M

E

Stage 2

Research

Evidence

1. Identify

problem and

research

question

2. Gather

relevant

evidence

3. Appraise

quality of

evidence

Professional

Role

Research

Expertise

Stage 3

Integration of

Evidence

1. Establish

applicability and

appropriateness

2. Determine

method

3. Identify

evaluation criteria

4. Anticipate outcomes

Professional

Role

Clinical

Expertise

Stage 4

Decision-

Making

1. Discuss

evidence with

client

2. Develop

collaborative

plans for

intervention

Collaborative Role

Professional

& Client

Stage 5

Enablement and

Evaluation

1. Further

assessments as

needed

2. Undertake

processes for

enablement

3. Evaluate

outcomes

Collaborative

Role

Professional &

Client

SPECIFIC CONTEXT OF PRACTICE

nursalam-2014

5. CONCLUSION? 1. EBP – VOCATIONAL IS THE BEST WAY TO

MEET PATIENT NEEDS

2. EBP IS CLINICAL GUIDELINES FOR

VOCATIONAL HEALTH WORKER

3. CONTEXT OF CARING IN EBP: CLINICAL

EVIDENCE & PATIENT VALUES; RESEARCH

EVIDENCE & THEORY; AND PROFESSIONAL

EXPERTISE DECISION MAKING

Making good contributions

to Patient safety

SUSTAIN QUALITY

AND PRODUCTIVITY

(REMEMBER

A-P-I)

Building skills and

competency

of nurses

Meeting client‟s needs now

and in the future

63 mtrla/13072010

THANK YOU & GOOD LUCK

References

Baras, E., & Boren, S. (2000). Managing clinical knowledge for

healthcare improvement (pp. 65-70). Germany: Schattauer Publishing.

Dee, C., & Stanley, e. (2005). Nurses‟ information needs: nurses‟ and

hospital librarians‟ perspective. J Hosp Librar, 5(2), 1-13.

Hallyburton, A., & St. John, B. (2009). Partnering with your library to

strengthen nursing research. J Nsg Educ, 49(3), 164-167.

McClure, M., & Hinshaw, A. (2002). Magnet hospital revisited.

Washington DC: ANA.

Pravikoff, D., Tanner, A., & Pierce, S. (2005). Readiness of US nurses

for evidence-based practice. AJN, 105(9), 40-51.

Rourke, D. (2007). The hospital library as a “Magnet Force”…Med Ref Svcs Quar, 26(3), 47-54.

Sherwill-Navarro, P., & Roth, K. (2007). Magnet hospital/magnetic

libraries. J Hosp Librar, 7(3), 21-31

Stetler C. et al. (1998). Evidence-based practice and the role of nursing leadership. JONA,

28(7/8), 45-53.

Stetler, C. et al. (1998). Utilization-focused integrative reviews. Appl

Nurs Res, 11(4).